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SUPPLIER REGISTRATION APPLICATION FORM
Application form must be completed in legible block letters.
It is the supplier’s responsibility to confirm receipt and submission of this application form
to the College.
It remains the responsibility of a registered supplier to inform the College in writing of any
change on company particulars.
Application form can be forwarded to: Central Office no 16 Market Street, POLOKWANE
at the reception.
NB: Suppliers will be subjected to vetting and screening.
APPLICANT DECLARATION
I declare that all the information provided herein is complete to the best of my knowledge. I understand that any false information supplied could lead to my application being disqualified.
__________________________Initials and Surname
_________________________ ________________________Signature Date
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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CAPRICORN COLLEGE FOR FETISO 9001:2008 Certificated
CENTRAL OFFICE16 Market Street Tel (015) 291 31180699 POLOKWANE (015) 291 3115Private Bag X9674 Fax (015) 291 27670700 POLOKWANE www.capricorncollege.co.za
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A. FULL DETAILS OF SUPPLIERS
REGISTERED NAME
TRADING NAME
REGISTRATION NUMBER
INCOME TAX REGISTRATION NUMBER
VAT REGISTRATION NUMBER
ID. NUMBER OF CONTACT PERSON
PHYSICAL ADDRESS
CITY/TOWN
LOCAL MUNICIPALITY
PROVINCE
POSTAL ADDRESS
B. TYPE OF BUSINESS(TICK ONE)
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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Close CorporationPublic Company (Ltd)Private Company (Pty)LtdPartnershipSole TraderBusiness TrustOther (Specify)
C. COMPANY CLASSIFICATION (Tick One)
SupplierManufacturerService ProviderOther Services
D. SMME STATUS OF THE COMPANY
Micro Annual TurnoverSmall Years in BusinessMedium Number of StaffLarge
E. DETAILS OF MAIN CONTACT PERSON
F. FIRST NAMES
G. TELEPHONE NUMBER
H. CELL NUMBER
I. FAX NUMBER
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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J. EMAIL ADDRESS
K. LIST OF PARTNERS, PROPRIETORS AND SHAREHOLDERS
1. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..
% owner by Shareholder
Qualify as black Qualify as woman
Qualify as disabled
Qualify as youth
YES NO YES NO YES NO YES NO
2. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..
% owner by Shareholder
Qualify as black Qualify as woman
Qualify as disabled
Qualify as youth
YES NO YES NO YES NO YES NO
3. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..
% owner by Shareholder
Qualify as black Qualify as woman
Qualify as disabled
Qualify as youth
YES NO YES NO YES NO YES NO
4. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..
% owner by Qualify as black Qualify as Qualify as Qualify as youth
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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Shareholder woman disabledYES NO YES NO YES NO YES NO
5. Full name:…………………………………………………………………………………………………………………………Position:…………………………………………………………………………………………………………………………..ID. No.:……………………………………………………………………………………………………………………………..
% owner by Shareholder
Qualify as black Qualify as woman
Qualify as disabled
Qualify as youth
YES NO YES NO YES NO YES NO
L. DECLARATION OF ANY CONFLICT OF INTERESTSAre you or any of your partner/s presently an employee of the government?
Yes no
If yes, please finish particulars:………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………
SUPPORTING DOCUMENTS
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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Company Profile Certified copy/ies of Company registration certificate. Valid original Tax Clearance Certificate. Certified copy/ies of members ID. Documents. BBBEE status verification certificate. Proof of registration with professional bodies, (If applicable) Proof of Banking Details.
CHECKLIST FOR COLLEGE OFFICIALS
(FOR OFFICE USE ONLY)
DOCUMENT ATTACHED YES NO N/A1. Certified Copy/ies of Company Registration Certificate2. Company Profile3. Valid Original Tax Clearance Certificate4. Affidavit Confirming Disability5. Certified Copy/ies of ID. Documents6. BBBEE Rating Certificate7. Professional Body/ies Registration/ Membership
Information checked by:
Employer’s name:___________________________________
Signature:__________________________________________
Date:_______________________________________________
Information captured by:
Employee’s name:…………………………………Signature…………………..Date……………….
Information verified by:
Employee’s name:…………………………………Signature…………………..Date……………….
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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LIST OF COMMODITIES AND SERVICES REQUIRED
A. CONSTRUCTION
Air conditioning System Carpentry Electric Contract Plumbing
B. Services
Conference Facilities Office Plant Printing and Photography (Annually Report) Cabling, DSTV, Networking and Visual Printer Cartridges Catering Computer Suppliers/services Courier Services Exhibition Centers Security Services Telecommunication Transport Services/ office movers Travel Agencies Accounting / Financial Advisory Services & Bookkeeping including
assisting incentives, critical Infrastructure FundEvent ManagementFencing and Fencing MaterialsFire Extinguishers & Maintenance Garden Equipment’s & SuppliersGiftsGlasswork & MaintenanceGroceriesIT InfrastructureLock SmithMedia PublicationOffice Curtains & Rails / BlindsPacking ShadesPest Control& Fumigation Promotional MaterialsSound & Stage_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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Sports WearTent and Chairs (Margueese Gazebo)CarpetsCleaning ServicesKitchen Appliances
ADDITIONAL (Add your service)
C. Legal intervention Attorneys/ Legal services Lease / Sales agreements Labour Relations Debt Collection Any Litigation Matters
D. ECD
Plumbing Level 2 Carpentry Leve2 Leather work Level 2 Brick Laying & Plastering Penal beating & Spraying Water & Sanitation Level 2 Welding Level 2 Food preparation Level 3 Computerized Financial System Level 4 Corporate behavior & Office Antiques Level 3
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POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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Financial Management Level 3E. PROFESSIONAL SERVICES
EDMS Consultants EPA Consultants Economist Industrial Relations Project Managers Quantity Surveyors
F. SMME’s Short Courses
Accounting & Bookkeeping Basic Business Skills Costing & Pricing Excel 2007/ Word 2007 Project Management Small Business Taxation Business Plan Conflict Resolution Customer Services Negotiations Skills
G. PLANNING INTERVENTION Feasibility Study / Business Plan Business Strategy Planning (Business Growth, Business Expansion,
Business Turnaround Plan and Business Evaluation Marketing Plan Marketing Research (Market Access, Evaluation and Analysis)
H. MARKETING TOOLS
Web Design Bronchus Business Cards Company Logo Branding (Corporate gifts & Clothing) Sign Boards / Street Poles
_____________________________________________________________________________________
POLOKWANE CAMPUS SENWABARWANA CAMPUS SESHEGO CAMPUSDie Meer Street Senwabarwana Main Street 1919 Freedom Drive0699 POLOKWANE 0790 SENWABARWANA 0742 SESHEGOTel: (015) 287 0400 Tel: (015) 505 3172 Tel: (015) 223 0006Fax: (015) 287 0439 Fax: (015) 505 3174 Fax: (015) 223 5187
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